Overview/Definition

Although fairly rare, spinal infections vary significantly. Among the most common are osteomyelitis, discitis, and epidural abscess. Osteomyelitis is an infection of the vertebral bone of the spinal column. Discitis, an infection of the disc space, involves an inflammatory lesion of the intervertebral disc. An epidural abscess is an infection that develops in the space around the dura, the tissue that surrounds the spinal cord and nerve root.

Symptoms

Osteomyelitis patients are generally ill with fever and severe back pain. Systemic symptoms such as chills, weight loss, difficult or painful urination, and intolerance to light may be present. If the disease has progressed, neurological symptoms may also be present. If there has been prior surgery, there may also be drainage from a wound or incision.

Discitis patients have few symptoms at first, but go on to develop severe back pain. Generally, children do not have elevated temperature or complain of severe pain, but will refuse to flex the spine.

Epidural abscess symptoms are generally less obvious, often consisting of little more than a pins and needles sensation or mild weakness.

Symptoms of post-operative infections include drainage from the wound, severe pain, fever, hematoma, and redness and swelling at the site of the incision.

Potential Causes

Osteomyelitis can be caused by either a bacterial or a fungal infection elsewhere in the body that has been carried into the spine through the blood stream. The most common source is a bacterium called Staphylococcus aureus. The veins in the lower spine come up through the pelvis. For this reason, spinal infections may occur after a urologic procedure (e.g., cystoscopy). Tuberculosis, although much more prevalent in underdeveloped countries, can also cause this type of infection.

Although most researchers believe discitis to be caused by infection, the cause has been the subject of some debate. The infection probably begins in one of the contiguous end plates, which leads to an infection in the disc.

Due to improved surgical techniques and the use of peri-operative antibiotics, post-operative spinal infections have become increasingly rare. However, a small percentage of such cases still occur.

Diagnosis

Treatment Options

Long-term antibiotic therapy, including both oral and intravenous therapies, is usually required for the treatment of osteomyelitis. If the vertebrae continue to deteriorate and if conservative treatments have been exhausted, surgery may be required to remove the infected fusion and stabilize the spine.

Most doctors treat discitis with plaster cast immobilization, an effective treatment in most cases. In some cases, antibiotics are also prescribed.

The treatment for an epidural abscess involves the removal of the infected tissue and administration of antibiotics.